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NEW DRUGS OF ABUSE&
NEW MEDICATIONS FOR THE TREATMENT OF
ADDICTION
Randall Webber, M.P.H.
Director of External Training
TASC, Inc.
Trends in Adolescent Drug Use:
2008 UpdateRandall Webber, M.P.H.
Director of External Training
TASC, Inc of Illinois
Overall Trends for Adolescents
• Less use of cocaine, PCP, LSD and other street drugs
• More use of both Rx drugs and over-the-counter (OTC) medications
• Greater “recreational” use of Adderall• Marijuana use relatively unchanged• Younger age of first use
The Problem with Pill Identifications:
New York City May 2000 Amphetamine
Chicago May 2000 MDMA
Tucson AZ July 2000 PMA
Portland Oct 2000 MDMA
PMA Effects -
• Sudden blood pressure rise (> 55mm)
• Hyperthermia usual cause of death
• Brain hemorrhage can occur• Does NOT produce the pleasant
Ecstasy effects so users take more causing an overdose.
• No hospital tests available for PMA.
Major Neurotransmitters
InhibitoryEndorphins
ExcitatoryAcetylcholine
InhibitoryGABA
ExcitatoryGlutamate
InhibitorySerotonin
Inhibitory/ExcitatoryDopamine
Methamphetamine and MDMA
MDMAMDMA MethamphetamineMethamphetamine
A hydrogen atom shifts position↑
↑two oxygen atoms are added
DXM Examples –No Urine Test Available
“Pink Molly” Buffalo NY
“Star” Indianapolis IN
“Clover” Wide spread across US
“Orange Julius” Seattle WA
“Green Triangle” Wide spread
Produces Produces Olney’s LesionsOlney’s Lesions On Lower Cortex On Lower Cortex
Age of First Non-Medical Use of Rx Drugs & Lifetime Diagnosis of
Substance Abuse
0
5
10
15
20
25
30
35
40
45
13 oryounger
21 orolder
Lifetime Dx of RxDrug Abuse
Number of New Users of Illicit Drugs: 2006
2.04
2.06
2.08
2.1
2.12
2.14
2.16
2.18
2.2
Rx OpiatesMarijuana
Source of Rx Opiates
0
10
20
30
40
50
60
Friend or Relative
Doctor
Drug Dealer/OtherStrangerInternet
Number of American 12+ y.o. who have used OxyContin VS Heroin
(In Millions)
0
2
4
6
8
10
12
LIFETIMENON-
MEDICALUSE
OxyContin
Heroin
% of Youth Who Believe that Trying Heroin Once or Twice Does NOT pose a
“Great Risk”
56
56.5
57
57.5
58
58.5
2002 2006
Youth 12-17
Types of Opiates
Naturally Occurring Opiates• Opium• Morphine• Codeine• Thebaine
Semi-Synthetic Opiates •Vicodin • Heroin
Types of Opiates
Synthetic opiates• Demerol (meperidine)• Dilaudid (hydromorphone)• Percodan/OxyContin (oxycodone)• Numorphan (oxymorphone)• Sublimaze (fentanyl)• Methadone (dolophine)• diphenoxylate/atropine (Lomotil)
Types of Opiates
• Karachi (Chicago area only)• No as common now as in 1990s• Drug composition varies. Usually
includes an opiate (ex: Methadone) and at least one sedative (ex: CNS diazepam, phenobarbital).
Opiate Withdrawal
– Drug hunger (craving)
– Dilated pupils– Yawning– Lacrimation (eyes tear)– Rhinitis (runny nose)– Restlessness– Anxiety– Depression– Muscle and bone pain
Opiate Withdrawal
– Stomach, leg and back cramps– Nausea– Insomnia – Diarrhea – Vomiting – Chills/cold flashes with goose
bumps ("cold turkey")– Sweating – Leg spasms (“kicking the habit”)
Reported Sources of Rx ADHD Medications Among Past-Year Non-medical Users, 2005*
0
10
20
30
40
50
60
70 Given by friend orfamily member
Taken/Stolen
ObtainedFraudulently fromdoctor
Bought fromfriend/family member
Internet pharmacy
* Among adults ages 18 to 49 without a prior diagnosis of or prescription for ADHD
Consequences of Long-Term ADHD Medication Use
(One Study)• Prescribed use of Ritalin among
preadolescents• Depression• Anxiety • Decreased ability to derive pleasure from
alcohol and other drugs (AOD)• Decreased ability to derive pleasure from
natural rewards (food, sex, etc.)• Potential outcome: Increased use of
AOD
“NEW” DRUGS
• Ambien (zolpidem tartrate)• Lunesta (eszopiclone )• Rozerem (Ramelteon)• DXM- Dextromethorphan
DXM- Dextromethorphan• May be mixed with or substituted for
MDMA (“ecstasy”)• In one study, 21% of “ecstasy”
contained DXM• Common cough suppressant drug• In therapeutic doses, is sedating• In larger doses, behaves like PCP
DXM Plateaus
• Abusers describe the DXM experience as occurring on four different plateaus. First Plateau: Mild inebriation. Second Plateau:
♦Effects similar to alcohol intoxication (slurred speech)
♦May be mild hallucinations. ♦Short-term memory may be temporarily impaired.
Third Plateau:
♦Impaired sense, particularly vision
DXM Plateaus
Fourth Plateau:
♦ Mind and body dissociation/"out-of-body" experience ♦ Loss of some or all of senses ♦ Effects at this plateau to ketamine or PCP.– detachment– disorientation– nystagmus – stupor – vomiting – “Robo Rash” itching.
Ambien (zolpidemtartrate )
• Non-benzodiazepine hypnotic• Available in 5-mg and 10-mg
tablets• Schedule IV substance• Effect of 40 mg similar to
Valium 20 mg
Ambien• Mechanism of action: Subunit
modulation of the GABA-A receptor chloride channel macromolecular complex
• GABA-A receptor complex:
– Is located on GABA alpha subunit
– Referred to as the benzodiazepine (BZ) or Ω (omega) receptor.
• At least three subtypes of this receptor have been identified.
Ambien• Indicated for the short-term
treatment of insomnia• Use should be limited to 7 to 10
days• Abnormal thinking and behavior
changes have been reported:– decreased inhibition (e.g.,
aggressiveness and extroversion that seems out of character)
– Sleep walking, driving, eating, cooking...
Ambien:
• Abnormal thinking and behavior– agitation– hallucinations– depersonalization– amnesia – In primarily depressed patients-
worsening of depression including suicidal thinking
Ambien: Withdrawal Symptoms
• Dysphoria• Panic attack & nervousness• Insomnia • Abdominal and muscle cramps• Nausea & Vomiting• Sweating• Lightheadedness• Tremors• Convulsions
Lunesta (eszopiclone )
• Thought to also work through various GABA subreceptors.
• Addiction potential unclear.
ZIMOVANE (Zopiclone)
• First introduced in 1988 as hypnotic agent
• Marketed in 85 foreign countries as Imovane® , but has never been registered in the U.S.
• Closely related to eszopiclone (Lunesta)
• Abuse and dependency has been documented
Rozerem (Ramelteon )• Appears to work through MT1 and MT2
(melatonin) receptors. • Has an addiction potential, but the
degree of this potential is unclear.• A highly unusual hypnotic, which
appears to work through melatonin receptors.
• Melatonin– A neurotransmitter that is manufactured from
serotonin– Involved in regulating circadian rhythms, and
physical responses to changes in seasons.
Rozerem (Ramelteon )• In clinical testing has shown no
potential for abuse. • Does not bind or attached to
receptors that affect memory, balance, cognition, or respiratory depression.